AccountId: 011433970860
ContactId: f4f9d3c9-4908-457d-8022-9c23c2daf3d9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1175099 ms
Total Talk Time (AGENT): 326291 ms
Total Talk Time (CUSTOMER): 564687 ms
Interruptions: 3
Overall Sentiment: AGENT=-0.2, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/26/f4f9d3c9-4908-457d-8022-9c23c2daf3d9_20250226T17:29_UTC.wav
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[AGENT][NEUTRAL] This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] in Broker Resources. How are you today?
[AGENT][NEUTRAL] I'm doing fine. How are you?
[CUSTOMER][POSITIVE] Pretty good. I've got a provider online and she is uh needing to verify benefits for an insured.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, the policy number is 2136485.
[CUSTOMER][NEUTRAL] And the policyholder is [PII], but it is for her son [PII], uh, and, uh, [PII] was able to verify his name and date of birth. Can you talk with her?
[AGENT][POSITIVE] OK, thank you. Yes, ma'am.
[CUSTOMER][POSITIVE] Thanks
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Good afternoon, [PII]. My name is [PII]. My last insurance is R as in Romeo. Uh, [PII], I would like to check the claim status for a few of the claims and uh reissue of the check studies for a few of my claims. Uh, can you, uh, spell me your name for the documentation purpose?
[AGENT][NEUTRAL] [PII] And how do you spell your name?
[CUSTOMER][NEUTRAL] My name is uh [PII].
[CUSTOMER][NEUTRAL] Last initial is [PII].
[AGENT][NEUTRAL] OK, and this is on [PII], you're [PII]?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] And what date of service?
[CUSTOMER][NEUTRAL] Data services [PII].
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][POSITIVE] Mhm. Take your time.
[AGENT][NEUTRAL] And what's the date of birth for [PII]?
[CUSTOMER][NEUTRAL] For [PII], the date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what's the procedure code for that claim?
[CUSTOMER][NEUTRAL] Procedure code. So here we have uh two procedure codes well on the line. The first procedure code was 99214. 2nd procedure code is 87,430.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, we have processed this claim 1234 times.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Office visits are not covered.
[CUSTOMER][NEUTRAL] OK. Uh, so this claim was denied as office visits are not covered, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And uh so it was as per the patients uh plan coverage type, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][POSITIVE] Mhm. Thank you so much. And may I know uh when was the last uh process claim was received and processed?
[AGENT][NEUTRAL] The last claim that we denied as a duplicate.
[CUSTOMER][NEGATIVE] Mhm. No, uh, the original, uh, denial which was uh office visit not payable.
[AGENT][NEGATIVE] That was the first time we ever received and then after that we deny duplicates.
[CUSTOMER][NEUTRAL] Mm mm.
[CUSTOMER][NEUTRAL] OK. Uh, so I would like to know about the status of the, uh, and the information regarding the first claim, which is the original claim. What is the receipt date for that?
[AGENT][NEUTRAL] Hold on, just
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][POSITIVE] Mm mhm. No issues.
[AGENT][NEUTRAL] And on the other procedure code we are asking for explanation of benefits for the 87,430.
[CUSTOMER][NEUTRAL] 48743. You need to submit. mhm OK. Uh.
[AGENT][NEUTRAL] 3.
[AGENT][NEUTRAL] Explanation of benefits from the primary insurance.
[CUSTOMER][NEUTRAL] Mhm. And upon further review, and I have found one of my previous colleagues has been already faxed the uh explanation of benefits from the primary to the fax number.
[AGENT][NEUTRAL] OK, hold on one moment, let me look up, look it up, OK?
[CUSTOMER][POSITIVE] Mhm. No issues. Take your time.
[AGENT][NEUTRAL] OK, that particular procedure code was paid $10.09.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Uh, may I know, uh, is, uh,
[CUSTOMER][NEUTRAL] Mhm. OK. So you said that particular procedure code was processed and paid, right? And it was $10.09. Did I get it correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Mhm. Great, thank you so much. And uh it was a payment through a check or EFT?
[AGENT][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm. And uh may I know, uh, is that a single check or bulk check?
[AGENT][NEUTRAL] Single.
[CUSTOMER][NEUTRAL] Mhm great and may I also have the check number?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][POSITIVE] Mhm. No issue. Take your time.
[AGENT][NEUTRAL] 1,833,410.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm sorry. Can you repeat that again?
[AGENT][NEUTRAL] 1,833,410.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Mhm. Great. Thank you so much. And uh may I know what uh whether the check was uh mhm. May I know when was the check issued?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 13124.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] 13124. Great. Thank you so much. And is that the check got cleared or not?
[AGENT][NEUTRAL] Hold on, I'll check.
[CUSTOMER][NEUTRAL] Mhm now just take it down.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][POSITIVE] No issues, ma'am. Take your time.
[AGENT][NEUTRAL] 41
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Sorry, sorry.
[CUSTOMER][NEUTRAL] And the balance and then.
[CUSTOMER][NEUTRAL] Be
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] No issues, ma'am. Take your time. And [PII], is there any um issues going on with the portal web portal? Because I was trying to look up or download some Us from the portal, but it shows uh there was an issue.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] And you were looking under this policy number?
[CUSTOMER][NEGATIVE] Uh no, actually not for this policy number. It was for a different policy numbers I had been looking for like uh past half an hour. It shows the same issue.
[AGENT][NEUTRAL] What's the other policy number?
[CUSTOMER][NEUTRAL] Which I was looking.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm. Yeah, the other policy number is 20, 02116669. And I had recently opened another one, so which is
[AGENT][NEUTRAL] Who was the patient on that one?
[CUSTOMER][NEUTRAL] Mhm. I'm sorry, what?
[AGENT][NEUTRAL] Who is the patient on that one for 211666-9?
[CUSTOMER][NEUTRAL] OK, uh, for that one, [PII].
[AGENT][NEUTRAL] Oh, OK. I'm not sure why it's not working on that one because this policy is active now. On the other one, the one prior that I'm helping you with now, it is not active anymore, so you may not be able to get any information on a lapse policy. I'm not sure.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Uh, but how about this one, which is the recent one I was looking. So this one was 02141171.
[AGENT][NEUTRAL] OK. What, what is the policy number again?
[CUSTOMER][NEUTRAL] 02141171.
[AGENT][NEUTRAL] That one you should be able to get in and look at the uh claim statuses on that one because it's active.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, uh, that's the reason I tried to look up, but when I opened and log in to the APO portal and uh when I was, uh, every information is gathered and when I tried to download the EOB, it was like um getting processed and then there was a pop-up message of oops, I can't able to access or something like that. Let me get into it again and uh give you the exact uh information which I get in the pop-up.
[CUSTOMER][NEUTRAL] And ma'am, have you got that uh check clear date?
[AGENT][NEGATIVE] I'm showing that check was voided. I'm not sure why, but it was voided for some reason.
[CUSTOMER][NEUTRAL] Mm mm.
[CUSTOMER][NEUTRAL] Mm, yes, uh, so actually,
[AGENT][NEUTRAL] So I'll have to check on that one.
[CUSTOMER][NEGATIVE] Mhm. Yeah, actually, so uh for the, for the past two days, I have been calling APR and some of the um check was void because it was not like cash from the issued date because of uh the incorrect uh pay to address in the [PII].
[AGENT][NEUTRAL] So you already talked to somebody on this one?
[CUSTOMER][NEUTRAL] No, not for the same patient, but for the different patient. It has uh like uh uh uh is the pay to address was [PII]? Is that the pay to address which I sent?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] This check right here was paid to [PII].
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] [PII]. OK, uh give me a minute. Actually, that is not the correct pay to address to pay uh for the tax number uh which we have updated the pay to address.
[AGENT][NEUTRAL] OK, we just pay what's on the claim because we get a lot of checks back from you all, so whatever is on that claim, that's what we pay. If that's not who you all need us to pay, then you need to put the correct address that you all want to be paid on that claim.
[CUSTOMER][NEUTRAL] So what
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, I totally agree and understand what you're trying to say. But however, this uh claims was like the past two years and uh the address which we have changed uh is a new address and uh we have already sent a 99 form to update the address and process to reissue the check.
[AGENT][NEUTRAL] OK, and you sent in a new, a new claim?
[CUSTOMER][NEUTRAL] Uh, can you check that weather?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Now, uh, at the same time, we have, uh, submitted a 99 form and uh so uh for the tax ID number [PII], sir.
[AGENT][NEUTRAL] But you submitted a new claim.
[AGENT][NEUTRAL] With the new with the correct address?
[CUSTOMER][NEUTRAL] No, there is no
[CUSTOMER][NEUTRAL] No, there is no new claim or the uh any changes for the same claim. We have just updated the 99 form and we faxed to APO. So and uh then there was in void of check and uh we have uh asking for the reissue of check.
[AGENT][NEUTRAL] If you want it issued to a certain address, then you'll have to send in a corrected claim most of the time.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm. Actually, uh, since the claim, yes, I do understand that, but for this claim, we have passed the correct claim on the filing limit, right?
[AGENT][NEUTRAL] Because this
[AGENT][NEGATIVE] See, no, there's no timely filing. See this claim right here, I don't know why it was sent to that PO box because it has [PII].
[AGENT][NEUTRAL] So, see, when y'all put all of these street addresses on here.
[CUSTOMER][NEUTRAL] That is uh
[AGENT][NEUTRAL] Then that's where it's gonna go.
[CUSTOMER][NEUTRAL] And well, actually,
[CUSTOMER][NEUTRAL] Yes, I totally agree, man. So I'm not uh denying it too, but we have already submitted the form to update the address, which is a WA form. We have faxed it to you.
[AGENT][NEUTRAL] Yes, I understand that, but we go by each claim when the claim comes in that's how we put it in to pay is that whatever is in that box 33, that's the address we're gonna pay.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But uh
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK. But uh yesterday, I spoke with one of your representative and got uh found that the claim was sent for, I mean, the check was sent to an incorrect address and got it uh yes, got it to reissued. So that is why I'm calling, I'm requesting you to check the uh address whether it has been updated for the tax ID number. And uh can you reissue this check?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] We can reissue this check, but I'm not gonna guarantee it's gonna go to whatever address because it's got, it's got that [PII]. We don't look at the, we look at the tax ID and the whatever mailing address is in [PII] when we get the claim. I understand you sent a W9 in to correct your address, but we have a bunch.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Of uh addresses for you all in the system. So when the claim comes in, we go by whatever is on the claim.
[AGENT][NEUTRAL] So we are having a lot of checks come back from Mercy Clinic East Community because the correct address is not being put on the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Yes, sir. I totally agree.
[AGENT][NEGATIVE] And we keep having to void, void, void, void all these chicks.
[AGENT][NEUTRAL] If y'all would just put the right address, where you want the checks to go on the claim.
[AGENT][NEUTRAL] Now every time we get in, we're not gonna go look over here and to see how many addresses it in. We're gonna go by the address that's in box [PII] on the claim.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] So every time a claims filed with that address that y'all don't want it to go to, that's where it's gonna go and then it's gonna have to be voided reissued.
[AGENT][NEGATIVE] And that's the problem.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Yes, I totally understand and agreeing what are you trying to say. And so, uh,
[CUSTOMER][NEUTRAL] Yeah, OK. Uh, thank you so much for that. And you said there is no correct claim timely filing, right? If I get this, if I get this corrected in the box number 32 with the correct mailing address and submitting, uh, submitting a corrected claim, it won't denied as a past timely filing or anything, right? Because uh it's been, uh, mhm.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right. We don't have family filing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. No, sure, then fine. Thank you so much. And uh so uh
[CUSTOMER][NEUTRAL] For the same patient, I have the uh different date of service and uh
[CUSTOMER][NEUTRAL] Give me a minute. Let me check it here one more thing.
[CUSTOMER][POSITIVE] OK, fine. Thank you so much. So you said this claim was uh paid, right? And uh may I also have the paychecks claim number?
[AGENT][NEUTRAL] The claim number was 341.
[AGENT][NEUTRAL] 254 9.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 2549. OK. And uh for the procedure code 99214, you said it was denied for office visits are not covered, right? Is that procedure code?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Office.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Mhm. Uh, is that procedure code as a separate claim number or it is under the same claim number?
[AGENT][NEUTRAL] It can be under the same claim number because we received it multiple times.
[CUSTOMER][POSITIVE] OK. Thank you so much for that information. And may I also have the uh received date and process date for this claim?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] To get my video.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, but.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Alright.
[AGENT][NEUTRAL] OK, it was received 12924.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It was paid 13124.
[CUSTOMER][POSITIVE] 13, 124. OK. Thank you so much for that information. OK, for today's call, I have got enough information from you, ma'am. Thank you so much and have a great day.
[AGENT][POSITIVE] Thank you, uh, [PII] for calling API. You have a good day as well.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Bye bye.